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Tackett S, Ng CJ, Sugarman J, Daniel EGS, Gopalan N, Tivyashinee T, Kamarulzaman A, Ali J. Defining Malaysia's health research ethics system through a stakeholder driven approach. Dev World Bioeth 2024; 24:74-83. [PMID: 36861660 PMCID: PMC10474241 DOI: 10.1111/dewb.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 03/03/2023]
Abstract
The need to understand the systems that support ethical health research has long been recognized, but there are limited descriptions of actual health research ethics (HRE) systems. Using participatory network mapping methods, we empirically defined Malaysia's HRE system. 13 Malaysian stakeholders identified 4 overarching and 25 specific HRE system functions and 35 actors internal and 3 external to the Malaysian HRE system responsible for those functions. Functions requiring the most attention were: advising on legislation related to HRE; optimizing research value to society; and defining standards for HRE oversight. Internal actors with the greatest potential for more influence were: the national network of research ethics committees; non-institution-based research ethics committees; and research participants. The World Health Organization, an external actor, had the largest untapped potential for influence overall. In summary, this stakeholder-driven process identified HRE system functions and actors that could be targeted to increase HRE system capacity.
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Choo JWS, Moosa AS, Koh JWM, Ng CJ, Tan NC. Empowering patients in primary care: a qualitative exploration of the usability and utility of an online diabetes self-management tool. BMC Prim Care 2024; 25:111. [PMID: 38605357 PMCID: PMC11010383 DOI: 10.1186/s12875-024-02358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Despite the potential advantages of Internet-based diabetes self-management education, its adoption was not widespread among Singapore's public primary care clinics (polyclinics). An interactive online tool was thus developed to help educate patients with Type 2 diabetes mellitus (T2DM), and was now ready for user testing before implementation. AIM To explore the perceived utility and usability of the educational tool in patients with suboptimally-controlled T2DM in a Singapore primary care setting. METHODS In-depth interviews were used to gather qualitative data from multi-ethnic Asian adults who had suboptimally-controlled T2DM. A total of 17 IDIs were conducted between April 2022 to March 2023, audio-recorded, transcribed, and analyzed to identify emergent themes via thematic analysis. RESULTS Regarding utility, users found the educational tool useful because it provided them with information that was comprehensive, accessible, reliable, and manageable. Regarding usability, the majority of users reported that the educational tool was easy to use, and suggested ways to improve navigational cues, visual clarity, readability and user engagement. CONCLUSION Participants generally found the educational tool useful and easy to use. A revised educational tool will be developed based on their feedback and implemented in clinical practice.
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Affiliation(s)
| | - Aminath Shiwaza Moosa
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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Wattanapisit A, Hemarachatanon P, Somrak K, Manunyanon S, Wattanapisit S, Amornsriwatanakul A, Katewongsa P, Sangkaew S, Vichitkunakorn P, Lee PY, Ramdzan SN, Salim H, Ng CJ, Stoutenberg M. Physical Activity with Sports Scientist (PASS) programme to promote physical activity among patients with non-communicable diseases: a pragmatic randomised controlled trial protocol. BMJ Open Sport Exerc Med 2024; 10:e001985. [PMID: 38601124 PMCID: PMC11002402 DOI: 10.1136/bmjsem-2024-001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
Physical activity (PA) effectively prevents and treats non-communicable diseases in clinical settings. PA promotion needs to be more consistent, especially in busy primary care. Sports scientists have the potential to support PA promotion in primary care. The Physical Activity with Sports Scientist (PASS) programme is created to personalise PA promotion led by a sports scientist in a primary care clinic. A pragmatic randomised controlled trial with two parallel groups will be conducted at a family medicine clinic. Physically inactive participants aged 35-70 years who have type 2 diabetes mellitus, hypertension or dyslipidaemia will be invited. The control group (n=60) will receive usual care. The intervention group (n=60) will receive the PASS programme and usual care. The PASS programme will consist of a tailored PA prescription after the physician's consultation at the first visit and monthly phone follow-ups. The primary outcome is the proportion of participants who have achieved the PA goal defined as aerobic activity (≥150 min/week of moderate to vigorous-intensity PA), muscle-strengthening activity (≥2 days/week of moderate or greater intensity) and multicomponent PA (≥2 days/week of moderate or greater intensity). Secondary outcomes are body composition and physical fitness. The primary and secondary outcomes will be measured and compared between the control and intervention groups at visit 1 (month 0: baseline measurements), visit 2 (months 3-4: follow-up measurements), visit 3 (months 6-8: end-point measurements) and visit 4 (months 9-12: continuing measurements). The study protocol was registered with the Thai Clinical Trials Registry. Trial registration number: TCTR20240314001.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Poramet Hemarachatanon
- Department of Sport and Exercise Science, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
| | - Kamlai Somrak
- Department of Community Nursing, School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- Department of Health Promotion, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Saranrat Manunyanon
- Division of Student Support and Development, Walailak University, Nakhon Si Thammarat, Thailand
| | | | | | - Piyawat Katewongsa
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Sorawat Sangkaew
- Department of Social Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Polathep Vichitkunakorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ping Yein Lee
- UMeHealth Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Siti Nurkamilla Ramdzan
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hani Salim
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Mark Stoutenberg
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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Moosa AS, Oka P, Ng CJ. Exploring primary care physicians' challenges in using home blood pressure monitoring to manage hypertension in Singapore: a qualitative study. Front Med (Lausanne) 2024; 11:1343387. [PMID: 38590317 PMCID: PMC10999538 DOI: 10.3389/fmed.2024.1343387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Objective Hypertension guidelines recommend using home blood pressure (HBP) to diagnose, treat and monitor hypertension. This study aimed to explore the challenges primary care physicians (PCPs) face in using HBP to manage patients with hypertension. Method A qualitative study was conducted in 2022 at five primary care clinics in Singapore. An experienced qualitative researcher conducted individual in-depth interviews with 17 PCPs using a semi-structured interview guide. PCPs were purposively recruited based on their clinical roles and seniority until data saturation. The interviews were audio-recorded, transcribed verbatim and managed using NVivo qualitative data management software. Analysis was performed using thematic analysis. Results PCPs identified variations in patients' HBP monitoring practices and inconsistencies in recording them. Access to HBP records relied on patients bringing their records to the clinic visit. A lack of seamless transfer of HBP records to the EMR resulted in an inconsistency in documentation and additional workload for PCPs. PCPs struggled to interpret the HBP readings, especially when there were BP fluctuations; this made treatment decisions difficult. Conclusion Despite strong recommendations to use HBP to inform hypertension management, PCPs still faced challenges accessing and interpreting HBP readings; this makes clinical decision-making difficult. Future research should explore effective ways to enhance patient self-efficacy in HBP monitoring and support healthcare providers in documenting and interpreting HBP.
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Affiliation(s)
- Aminath Shiwaza Moosa
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Prawira Oka
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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Utap MS, Ng CJ, Lee YK, Kiyu A. Prevalence Trend and Clinical Profile of Leprosy Among the Indigenous Penan Community in Rural Baram, Sarawak, Malaysia: A Retrospective Study. Asia Pac J Public Health 2024; 36:219-224. [PMID: 38258742 DOI: 10.1177/10105395241227507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
In Malaysia, despite achieving leprosy-elimination status in 1994, leprosy remains a public health issue among the indigenous Penan community in Sarawak. This study aimed to determine the prevalence trend and clinical profile of leprosy among the Penans in rural Baram, Sarawak, Malaysia. A retrospective records review was conducted on 10-year (2008-2018) time trend of annual prevalence rate and 5-year (2013-2018) Penan leprosy patient clinical profile. Out of the 257 new cases of leprosy reported in Sarawak, 42.8% were Penans, and 72.7% were from Baram. The annual Penan ethnic-specific prevalence rate ranged from 2.08 to 35.5/10 000. Forty-six cases were analyzed for clinical profile: There were more males, active case detection, and multibacillary leprosy. The prevalence trend of leprosy among the Penans in rural Baram exceeded recommended elimination targets. Majority of the cases were detected through active case detection, but cases were detected late. Interventions are needed to improve early diagnosis and detection to achieve elimination of leprosy.
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Affiliation(s)
| | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Andrew Kiyu
- Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Malaysia
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Ng WL, Hussein N, Ng CJ, Qureshi N, Lee YK, Kwan Z, Kee BP, Then SM, Abdul Malik TF, Mohd Zaidan FZ, Azmi SUF. Implementing HLA-B*58:01 testing prior to allopurinol initiation in Malaysian primary care setting: A qualitative study from doctors' and patients' perspective. PLoS One 2024; 19:e0296498. [PMID: 38206925 PMCID: PMC10783771 DOI: 10.1371/journal.pone.0296498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Allopurinol, the first-line treatment for chronic gout, is a common causative drug for severe cutaneous adverse reactions (SCAR). HLA-B*58:01 allele was strongly associated with allopurinol-induced SCAR in Asian countries such as Taiwan, Japan, Thailand and Malaysia. HLA-B*58:01 screening before allopurinol initiation is conditionally recommended in the Southeast-Asian population, but the uptake of this screening is slow in primary care settings, including Malaysia. This study aimed to explore the views and experiences of primary care doctors and patients with gout on implementing HLA-B*58:01 testing in Malaysia as part of a more extensive study exploring the feasibility of implementing it routinely. METHODS This qualitative study used in-depth interviews and focus group discussions to obtain information from patients with gout under follow-up in primary care and doctors who cared for them. Patients and doctors shared their gout management experiences and views on implementing HLA-B*58:01 screening in primary care. Data were coded and analysed using thematic analysis. RESULTS 18 patients and 18 doctors from three different healthcare settings (university hospital, public health clinics, private general practitioner clinics) participated. The acceptability to HLA-B*58:01 screening was good among the doctors and patients. We discovered inadequate disclosure of severe side effects of allopurinol by doctors due to concerns about medication refusal by patients, which could potentially be improved by introducing HLA-B*58:01 testing. Barriers to implementation included out-of-pocket costs for patients, the cost-effectiveness of this implementation, lack of established alternative treatment pathway besides allopurinol, counselling burden and concern about genetic data security. Our participants preferred targeted screening for high-risk populations instead of universal screening. CONCLUSION Implementing HLA-B*58:01 testing in primary care is potentially feasible if a cost-effective, targeted screening policy on high-risk groups can be developed. A clear treatment pathway for patients who test positive should be made available.
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Affiliation(s)
- Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Norita Hussein
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Nadeem Qureshi
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Boon Pin Kee
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sue-Mian Then
- Division of Biomedical Science, School of Pharmacy, Faculty of Science and Engineering, University of Nottingham, Selangor, Malaysia
| | - Tun Firzara Abdul Malik
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Lim HM, Ng CJ, Abdullah A, Danee M, Raubenheimer J, Dunn AG. Online health information behaviour and its association with statin adherence in patients with high cardiovascular risk: A prospective cohort study. Digit Health 2024; 10:20552076241241250. [PMID: 38515614 PMCID: PMC10956144 DOI: 10.1177/20552076241241250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Objective Statins are effective for preventing cardiovascular disease. However, many patients decide not to take statins because of negative influences, such as online misinformation. Online health information may affect decisions on medication adherence, but measuring it is challenging. This study aimed to examine the associations between online health information behaviour and statin adherence in patients with high cardiovascular risk. Methods A prospective cohort study involving 233 patients with high cardiovascular risk was conducted at a primary care clinic in Malaysia. Participants used a digital information diary tool to record online health information they encountered for 2 months and completed a questionnaire about statin necessity, concerns and adherence at the end of the observation period. Data were analysed using structural equation modelling. Results The results showed that 55.8% (130 of 233 patients) encountered online health information. Patients who actively sought online health information (91 of 233 patients) had higher concerns about statin use (β = 0.323, p = 0.023). Participants with higher concern about statin use were also more likely to be non-adherent (β = -0.337, p < 0.001). Patients who actively sought online health information were more likely to have lower statin adherence, mediated by higher concerns about statin use (indirect effect, β = -0.109, p = 0.048). Conclusions Our results suggest that patients with higher levels of concern about statins may be actively seeking online information about statins, and their concerns might influence how they search, what they find, and the potential to encounter misinformation. Our study highlights the importance of addressing patients' concerns about medications to improve adherence.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jacques Raubenheimer
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Adam G. Dunn
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
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Lim HM, Ng CJ, Dunn AG, Abdullah A. Experiences and influences of online health information-seeking about statin use in patients with high cardiovascular risk: a qualitative study. Fam Pract 2023; 40:796-804. [PMID: 36994973 DOI: 10.1093/fampra/cmad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Online health information (OHI) has been shown to influence patients' health decisions and behaviours. OHI about statins has created confusion among healthcare professionals and the public. This study explored the views and experiences of patients with high cardiovascular risk on OHI-seeking about statins and how OHI influenced their decision. DESIGN This was a qualitative study using semi-structured in-depth interviews. An interpretive description approach with thematic analysis was used for data analysis. SETTING An urban primary care clinic in Kuala Lumpur, Malaysia. PARTICIPANTS Patients aged 18 years and above who had high cardiovascular risk and sought OHI on statins were recruited. RESULTS A total of 20 participants were interviewed. The age of the participants ranged from 38 to 74 years. Twelve (60%) participants took statins for primary cardiovascular disease prevention. The duration of statin use ranged from 2 weeks to 30 years. Six themes emerged from the data analysis: (i) seeking OHI throughout the disease trajectory, (ii) active and passive approaches to seeking OHI, (iii) types of OHI, (iv) views about statin-related OHI, (v) influence of OHI on patients' health decisions, and (vi) patient-doctor communication about OHI. CONCLUSION This study highlights the changing information needs throughout patient journeys, suggesting the opportunity to provide needs-oriented OHI to patients. Unintentional passive exposure to OHI appears to have an influence on patients' adherence to statins. The quality of patient-doctor communication in relation to OHI-seeking behaviour remains a critical factor in patient decision-making.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Duke-NUS Medical School, Singapore
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tun Firzara AM, Teo CH, Teh SY, Su JY, Mohd Zaini HS, Suhaimi A, Ng WL, Danaee M, Stevenson K, Mallen CD, Ng CJ. Evaluation of an electronic clinical decision support system (DeSSBack) to improve low back pain management: a pilot cluster randomized controlled trial. Fam Pract 2023; 40:742-752. [PMID: 37237425 DOI: 10.1093/fampra/cmad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a common reason for primary care consultation; yet doctors often find managing it challenging. An electronic decision support system for LBP (DeSSBack) was developed based on an evidence-based risk stratification tool to improve the management of patients with LBP in a Malaysian primary care setting. This pilot study aimed to assess the feasibility, acceptability, and preliminary effectiveness of DeSSBack for the conduct of a future definitive trial. METHODS A pilot cluster randomized controlled trial (cRCT) with qualitative interviews was conducted. Each primary care doctor was considered a cluster and randomized to either the control (usual practice) or intervention (DeSSBack) group. Patient outcomes including Roland-Morris Disability Questionnaire (RMDQ), Hospital Anxiety and Depression Scale, and a 10-point pain rating scale were measured at baseline and 2-month postintervention. The doctors in the intervention group were interviewed to explore feasibility and acceptability of using DeSSBack. RESULTS Thirty-six patients with nonspecific LBP participated in this study (intervention n = 23; control n = 13). Fidelity was poor among patients but good among doctors. The RMDQ and anxiety score had medium effect sizes of 0.718 and 0.480, respectively. The effect sizes for pain score (0.070) and depression score were small (0.087). There was appreciable acceptability and satisfaction with use of DeSSBack, as it was helpful in facilitating thorough and standardized management, providing appropriate treatment plans based on risk stratification, improving consultation time, empowering patient-centred care, and easy to use. CONCLUSIONS A future cRCT to evaluate the effectiveness of DeSSBack is feasible to be conducted in a primary care setting with minor modifications. DeSSBack was found useful by doctors and can be improved to enhance efficiency. TRIAL REGISTRATION The protocol of the cluster randomized controlled trial was registered at ClinicalTrials.gov (NCT04959669).
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Affiliation(s)
- Abdul Malik Tun Firzara
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
- UM eHealth Unit, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Shu Yi Teh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Je Yu Su
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hana Salwani Mohd Zaini
- Department of Information Technology, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia
| | - Anwar Suhaimi
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kay Stevenson
- School of Allied Health Professions, Keele University, Staffordshire ST5 5BG, United Kingdom
- Impact Accelerator Unit, Medical School, Keele University, Staffordshire ST5 5BG, United Kingdom
- Midlands Partnership University NHS Foundation Trust, Staffordshire ST6 7AG, United Kingdom
| | | | - Chirk Jenn Ng
- Department of Research, SingHealth Polyclinics, SingHealth, Singapore 150167, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
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Tan JYH, Ng CJ. Prevalence and burden of diabetes mellitus-related symptoms in patients with type 2 diabetes mellitus: A cross-sectional study. Malays Fam Physician 2023; 18:71. [PMID: 38213386 PMCID: PMC10781611 DOI: 10.51866/oa.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is a significant non-communicable disease in Malaysia, with a prevalence of 18.1%, per the National Health and Morbidity Survey. This study aimed to determine the prevalence and burden of diabetes mellitus-related symptoms and whether these symptoms were addressed by primary care doctors. Methods This 1-month cross-sectional study was conducted at an urban hospital-based primary care clinic in Malaysia. Patients with T2DM were recruited using systematic random sampling. Participants answered a self-administered questionnaire adapted from the Diabetes Symptom Checklist-Revised, which evaluated the sociodemographic characteristics, burden of diabetes mellitus-related symptoms in the past month and post-consultation feedback about symptoms. Data were analysed using SPSS. Results Four hundred eighteen participants were included, yielding a response rate of 97.7%. Hyperglycaemia was the most prevalent symptom, with 48.1% of the participants reporting a frequent need to empty their bladder. Most participants experienced a low symptom burden, so 56.7% did not report their symptoms to their doctors. The participants who reported their symptoms had a higher symptom burden. Among them, 97.5% indicated that their doctors addressed their symptoms. Approximately 78% reported satisfaction and good coping skills when their symptoms were addressed. Conclusion Hyperglycaemia was the most prevalent diabetes mellitus-related symptom among the patients with T2DM. The symptom burden was generally low, so most patients did not report their symptoms to their doctors. Those who reported their symptoms had a higher symptom burden. Further studies must explore why patients do not report their symptoms and how doctors address patients' symptoms.
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Affiliation(s)
- Jonathan Yuet Han Tan
- MD, M.FamMed, Klinik Kesihatan Sungai Manila, D/A32 Pejabat Kesihatan Kawasan Sandakan,Tingkat 6, Rumah Persekutuan Sandakan, Sandakan, Sabah, Malaysia,
| | - Chirk Jenn Ng
- MBBS, MMed Family Medicine, PhD, Health Services & Systems Research, Duke NUS Medical School, 8 College Road, Singapore
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Lim HM, Ng CJ, Abdullah A, Dunn AG. How do patients with high cardiovascular risk evaluate online health information? A qualitative study. BMC Prim Care 2023; 24:240. [PMID: 37964208 PMCID: PMC10647114 DOI: 10.1186/s12875-023-02182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND People are exposed to variable health information from the Internet, potentially influencing their health decision-making and behaviour. It remains a challenge for people to discern between good- and poor-quality online health information (OHI). This study explored how patients evaluate and determine trust in statin-related OHI in patients with high cardiovascular risk. METHODS This qualitative study used vignettes and think-aloud methods. We recruited patients from a primary care clinic who were at least 18 years old, had high cardiovascular risk and had previously sought OHI. Participants were given two statin-related vignettes: Vignette 1 (low-quality information) and Vignette 2 (high-quality information). Participants voiced their thoughts aloud when reading the vignettes and determined the trust level for each vignette using a 5-point Likert scale. This was followed by a semi-structured interview which was audio-recorded and transcribed verbatim. The transcripts were coded and analysed using thematic analysis. RESULTS A total of 20 participants were recruited, with age ranging from 38-74 years. Among all the high cardiovascular-risk participants, eight had pre-existing cardiovascular diseases. For Vignette 1 (low-quality information), five participants trusted it while nine participants were unsure of their trust. 17 participants (85%) trusted Vignette 2 (high-quality information). Five themes emerged from the analysis of how patients evaluated OHI: (1) logical content, (2) neutral stance and tone of OHI content, (3) credibility of the information source, (4) consistent with prior knowledge and experience, and (5) corroboration with information from other sources. CONCLUSION Patients with high cardiovascular risks focused on the content, source credibility and information consistency when evaluating and determining their trust in statin-related OHI. Doctors should adopt a more personalised approach when discussing statin-related online misinformation with patients by considering their prior knowledge, beliefs and experience of statin use.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
- Department of Research, SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5)#15-10, Singapore, 150167, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Leow MQH, Moosa AS, Salim H, Abdullah A, Lee YK, Ng CJ, Tan NC. Innovation workshop using design thinking framework and involving stakeholders to co-create ideas for management of asthma. NPJ Prim Care Respir Med 2023; 33:36. [PMID: 37925475 PMCID: PMC10625588 DOI: 10.1038/s41533-023-00357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
| | | | - Hani Salim
- Universiti Putra Malaysia, Serdang, Malaysia
| | | | | | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Chan XBV, Tan NC, Ng MCW, Ng DX, Koh YLE, Aau WK, Ng CJ. Prevalence and healthcare utilization in managing herpes zoster in primary care: a retrospective study in an Asian urban population. Front Public Health 2023; 11:1213736. [PMID: 37780417 PMCID: PMC10540814 DOI: 10.3389/fpubh.2023.1213736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Herpes zoster (HZ) causes significant morbidity, particularly in older adults. With the advent of a recombinant zoster vaccine, HZ is potentially preventable. However, data on HZ burden and healthcare utilization in primary care populations remains scarce. This study described the prevalence and healthcare utilization in managing HZ in a developed community. A retrospective database review was conducted across a cluster of 8 public primary care clinics in urban Singapore. Data of multi-ethnic Asian patients with a diagnosis code of "herpes zoster" from 2018 to 2020 was extracted from their electronic medical records. Socio-demographic, clinical, visitation, medical leave, prescription, and referral data were analyzed. A total of 2,987 out of 737,868 individuals were diagnosed with HZ over 3 years. The mean age was 59.9 (SD + 15.5) years; 49.2% were male; 78.5% Chinese, 12.2% Malay, and 4.1% Indian. The prevalence was 221, 224, 203 per 100,000 persons in 2018, 2019, and 2020, respectively. The 70 to 79-year age group had the highest prevalence (829/100,000) across 3 years. Oral acyclovir (median daily dose 4,000 mg; median duration 7 days) and topical acyclovir were prescribed in 71.6 and 47.6%, respectively. Analgesia prescribed were gabapentin (41.0%), paracetamol combinations (30.1%), oral NSAIDs (23.7%), opioids (6.0%), and tricyclic antidepressants (1.9%). Most individuals consulted only once (84.3%); 32.7% of them required medical leave and 5.6% had more than 7 days of absenteeism. HZ-related referrals to the hospital were required in 8.9% (4.9% emergency, 2.8% ophthalmology). The findings of this study suggest a need for HZ vaccination among older age groups. Visitation and referral rates were low. The use of topical acyclovir was uncovered, and further research should evaluate the underlying reasons, benefits, and harms of such practice. The use of analgesia combinations may be explored further.
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Affiliation(s)
- Xin-Bei Valerie Chan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Mark Chung Wai Ng
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | | | | | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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14
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Lim HM, Ng CJ, Abdullah A, Dalmazzo J, Lim WX, Lee KH, Dunn AG. Utility and usability evaluation of an information diary tool to measure health information access and exposure among patients with high cardiovascular risk. Front Public Health 2023; 11:1132397. [PMID: 37228723 PMCID: PMC10203480 DOI: 10.3389/fpubh.2023.1132397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background Online health misinformation about statins potentially affects health decision-making on statin use and adherence. We developed an information diary platform (IDP) to measure topic-specific health information exposure where participants record what information they encounter. We evaluated the utility and usability of the smartphone diary from the participants' perspective. Methods We used a mixed-method design to evaluate how participants used the smartphone diary tool and their perspectives on usability. Participants were high cardiovascular-risk patients recruited from a primary care clinic and used the tool for a week. We measured usability with the System Usability Scale (SUS) questionnaire and interviewed participants to explore utility and usability issues. Results The information diary was available in three languages and tested with 24 participants. The mean SUS score was 69.8 ± 12.9. Five themes related to utility were: IDP functions as a health information diary; supporting discussion of health information with doctors; wanting a feedback function about credible information; increasing awareness of the need to appraise information; and wanting to compare levels of trust with other participants or experts. Four themes related to usability were: ease of learning and use; confusion about selecting the category of information source; capturing offline information by uploading photos; and recording their level of trust. Conclusion We found that the smartphone diary can be used as a research instrument to record relevant examples of information exposure. It potentially modifies how people seek and appraise topic-specific health information.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jason Dalmazzo
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Woei Xian Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Hang Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam G. Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Tackett S, Jenn Ng C, Sugarman J, Daniel EGS, Gopalan N, Tivyashinee, Kamarulzaman A, Ali J. A Competency Framework for Health Research Ethics Educational Programs: Results from a Stakeholder-Driven Mixed-Method Process. Ethics Hum Res 2023; 45:29-39. [PMID: 37167475 PMCID: PMC10228593 DOI: 10.1002/eahr.500166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Educational programs are integral to building health research ethics (HRE) capacity, but no outcomes framework exists to guide them. We empirically developed a competency framework for health research ethics education-the Framework for Research Ethics Studies Competencies and Outcomes (FRESCO)-using mixed methods, including group concept mapping and a survey of international experts. FRESCO includes seven competency domains: (1) Foundational Knowledge; (2) Laws, Regulations, Guidelines, and Policies for Research Oversight; (3) Ethical-Issue Identification, Analysis, and Resolution; (4) Engagement, Communication, and Advocacy; (5) Lifelong Learning, Education, Research, and Scholarship; (6) Coordination, Stewardship, and Responsiveness in HRE Systems; and (7) Impartiality, Honesty, and Responsibility. These domains are detailed in 27 subdomains. Survey respondents rated FRESCO's relevance to HRE highly. FRESCO can be adapted and implemented in educational programs to refine recruitment and selection processes, educational and assessment methods, and performance measures to ensure that HRE educational programs have their intended effects.
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Affiliation(s)
- Sean Tackett
- Associate professor of medicine at the Johns Hopkins University School of Medicine and the international medical education director in the Division of General Internal Medicine at Johns Hopkins Bayview Medical Center
| | - Chirk Jenn Ng
- Clinical professor of family medicine at Duke-NUS Medical School and an Honorary Professor at the Faculty of Medicine at the Universiti Malaya
| | - Jeremy Sugarman
- Harvey M. Meyerhoff Professor of Bioethics and Medicine at the Berman Institute of Bioethics and the Department of Medicine at the Johns Hopkins University
| | | | - Nishakanthi Gopalan
- Senior lecturer at the Medical Humanities and Ethics Unit at the Faculty of Medicine at Universiti Malaya and the program coordinator for the Master of Health Research Ethics program
| | - Tivyashinee
- Medical graduate from Perdana University-Royal College of Surgeons in Ireland and a manager for the Master of Health Research Ethics program
| | - Adeeba Kamarulzaman
- Professor of medicine and infectious diseases at the University Malaya Medical Centre and the director of the Centre of Excellence in Research on AIDS at the University of Malaya
| | - Joseph Ali
- Associate professor of international health at the Johns Hopkins Bloomberg School of Public Health and a member of the core faculty and the associate director for Global Programs at Johns Hopkins Berman Institute of Bioethics
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Ng WL, Toh JY, Ng CJ, Teo CH, Lee YK, Loo KK, Abdul Hadi H, Noor Azhar AM. Self-care practices and health-seeking behaviours in patients with dengue fever: A qualitative study from patients' and physicians' perspectives. PLoS Negl Trop Dis 2023; 17:e0011302. [PMID: 37104529 PMCID: PMC10168551 DOI: 10.1371/journal.pntd.0011302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/09/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Outpatient management for dengue fever is the mainstay of treatment for most dengue cases. However, severe dengue can develop rapidly while patients are at home. Understanding the self-care practices and healthcare-seeking behaviours among dengue patients managed as outpatients will help improve the delivery of care to these patients. OBJECTIVE This study aimed to explore the self-care practices, health-seeking behaviour and outpatient management of dengue fever from the perspectives of patients and primary care physicians. METHODOLOGY This qualitative study used in-depth interviews and focus group discussions to obtain information from laboratory-confirmed dengue patients who received outpatient care and primary care physicians who cared for them. Patients and physicians shared their experiences and perceptions of self-care practices, decisions to seek urgent care, and outpatient management procedures and visit frequency. Data were coded and analysed using thematic analysis. RESULTS 13 patients and 11 physicians participated. We discovered that the use of traditional remedies was common with patients perceiving no harm from it, whereas physicians did not see a benefit. Dengue patients' knowledge of warning signs was inadequate despite the information being provided by physicians during clinical follow-up visits. Regarding the decision to seek urgent medical care, physicians assumed patients would seek help immediately once they experienced warning signs. However, for the patients, other factors influenced their health-seeking behaviour, such as their personal perceptions of symptom severity and often more importantly, their social circumstances (e.g., availability of childcare). Patients also described regular outpatient follow-up for dengue as inconvenient. There was variation in the prescribed outpatient follow-up interval recommended by participating physicians who complained about the lack of clear guidelines. CONCLUSION Perceptions around self-care practices, health-seeking behaviour and outpatient management of dengue often differed between physicians and patients, especially on comprehension of dengue warning signs. Addressing these gaps between patient and physician perceptions and recognition of patient drivers of health-seeking behaviour are needed to improve the safety and delivery of outpatient care for dengue patients.
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Affiliation(s)
- Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jia Yong Toh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Chin Hai Teo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kim Kee Loo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Haireen Abdul Hadi
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Soon CSL, Tudor Car L, Ng CJ, Tan NC, Smith H. What Is the Utility of Posters? Qualitative Study of Participants at a Regional Primary Healthcare Conference in Asia. Med Sci Educ 2022; 32:1405-1412. [PMID: 36345366 PMCID: PMC9631582 DOI: 10.1007/s40670-022-01657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Posters are used extensively as a mode of presentation at scientific conferences, but little is documented about their value to presenters or viewers. The study aimed to explore conference delegates' views and experiences of poster presentations, and their perceptions of the strengths and weaknesses of posters compared with oral presentations, and also to identify ways to enhance the educational value of posters. METHOD This was a qualitative study using brief, semi-structured, face-to-face interviews amongst delegates at a 3-day Asia Pacific regional academic primary care conference in Singapore. Interviews were digitally recorded, transcribed verbatim, and their contents analysed thematically. RESULTS Eighty-nine interviews were analysed. Respondents were mainly early career researchers (58%), and a third were presenting (poster or oral) at the conference. Many positive attributes of posters were identified. For the viewers, these included the ability to gain a rapid overview of research activity (for "benchmarking", "updating", and "inspiration"); the ability to choose who to engage with and when, in contrast to the tightly scheduled oral sessions; and opportunity to discuss content in a leisurely and detailed fashion with the presenter. Presenters considered posters "less threatening" than oral presentations and valued posters for the networking opportunities they created. However, posters were reported to be more demanding on the skills of précis and their preparation was considered arduous and more expensive than an oral presentation. Posters were also perceived to have lower academic status and dominate the presenter's time at the conference, reducing the opportunities for them to see the work of others. Suggestions for incorporating technologies to enhance the impact of posters included QR codes to access more detailed information, pre-recorded presentations, and online interactive clarification sessions with poster authors. CONCLUSION Posters are perceived as a valuable mode of presentation at scientific conferences by presenters and viewers. Their unique strengths challenge the perception that posters are somehow inferior to oral presentations, suggesting a need for their advantages to be promoted by researchers and conference organisers. The incorporation of technology within the traditional display may enhance poster utility. Given the time and money spent on academic conferences there is an urgent need to evaluate the different styles of presentation used at conferences and how they differ in their ability to impact on medical science knowledge and evidence-based clinical practice. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01657-z.
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Affiliation(s)
- Charlene S. L. Soon
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Novena, Singapore, 308232 Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Novena, Singapore, 308232 Singapore
| | - Chirk Jenn Ng
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Helen Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Novena, Singapore, 308232 Singapore
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Yusof MYPM, Teo CH, Ng CJ. Electronic informed consent criteria for research ethics review: a scoping review. BMC Med Ethics 2022; 23:117. [DOI: 10.1186/s12910-022-00849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The research shows a growing trend in using an electronic platform to supplement or replace traditional paper-based informed consent processes. Instead of the traditionally written informed consent document, electronic informed consent (eConsent) may be used to assess the research subject’s comprehension of the information presented. By doing so, respect for persons as one of the research ethical principles can be upheld. Furthermore, these electronic methods may reduce potential airborne infection exposures, particularly during the pandemic, thereby adhering to the beneficence and nonmaleficence principle. This scoping review aims to identify the ethics related criteria that have been included in electronic informed consent processes and to synthesize and map these criteria to research ethics principles, in order to identify the gaps, if any, in current electronic informed consent processes.
Methods
The search was performed based on internet search and three main databases: PubMed, SCOPUS and EBSCO. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation guideline was used to report this work.
Results
Of 34 studies that met the inclusion criteria, 242 essential original constructs were collated, and 7 concepts were derived. Digital content showed the highest percentage of collated original constructs (27%, n = 65) followed by accessibility (24%, n = 56), comprehension engagement (18%, n = 43), autonomy (14%, n = 34), confidentiality (11%, n = 25), language (5%, n = 13), and parental consent (1%, n = 2). Twenty-five new items were synthesized for eConsent criteria which may provide guidance for ethical review of research involving eConsent.
Conclusion
The current study adds significant value to the corpus of knowledge in research ethics by providing ethical criteria on electronic informed consent based on evidence-based data. The new synthesized items in the criteria can be readily used as an initial guide by the IRB/REC members during a review process on electronic informed consent and useful to the future preparation of a checklist.
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Wattanapisit A, Ng CJ, Angkurawaranon C, Wattanapisit S, Chaovalit S, Stoutenberg M. Summary and application of the WHO 2020 physical activity guidelines for patients with essential hypertension in primary care. Heliyon 2022; 8:e11259. [PMID: 36325139 PMCID: PMC9618974 DOI: 10.1016/j.heliyon.2022.e11259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/15/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
The new World Health Organization (WHO) 2020 guidelines on physical activity (PA) and sedentary behavior include recommendations for adults with chronic conditions. The guidelines provide adaptable and general recommendations for people living with chronic medical conditions. This article summarizes the content and provides suggestions for the application of the guidelines for patients with essential hypertension in primary care. The WHO 2020 PA guidelines recommend broad advice for adults and older adults with chronic conditions. The key recommendations are consistent with other hypertension guidelines. A systemic approach to promote PA in primary care (i.e., PA assessment, safety considerations, PA prescription, behavioral counseling, and referral) along with applying the WHO guidelines is required. Health risk assessment and safety issues related to hypertension (e.g., current PA levels, level of blood pressure, treatment plans, comorbidities) should be concerned. The FITT Pro (frequency, intensity, time, type, and progression) can be adopted as a framework to break down the guidelines into specific PA prescription. The WHO 2020 PA guidelines address the importance of PA in clinical populations. The guidelines can be adapted for patients with hypertension in primary care settings.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand,Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,SingHealth Polyclinics, Singapore, Singapore,Duke-NUS Medical School, Singapore, Singapore
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand,Corresponding author.
| | | | - Sirawee Chaovalit
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Mark Stoutenberg
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, USA
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Kaur S, Tan Kiak Min M, Ng SH, Ng CJ. Ethical challenges in clinical practice during the COVID-19 pandemic
in an academic healthcare institution in Malaysia: A qualitative
study. Clinical Ethics 2022. [PMCID: PMC9596680 DOI: 10.1177/14777509221134499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Healthcare professionals (HCPs) face a myriad of ethical challenges during
the coronavirus disease 2019 (COVID-19) pandemic. However, there is limited
literature examining the ethical challenges faced by HCPs in low- and
medium-income countries. The research was designed to explore the ethical
challenges experienced by HCPs in a Malaysian hospital setting during the
pandemic. Methods Semistructured interviews were conducted via video calls with 10 Malaysian
HCPs across different clinical disciplines involved in managing patients
diagnosed with COVID-19 infections. The calls were audio-recorded,
transcribed verbatim and checked. Thematic analysis with constant comparison
across transcripts was carried out to identify categories and themes. Results Three main themes emerged. Firstly, there was deprioritisation of care for
non-COVID-19 patients resulting from resource limitations. HCPs raised
concerns that there was curtailed access to various healthcare services by
non-COVID-19 patients. There was also a trade-off between protecting
individual patient safety and public health interests. Secondly, patients
were disempowered from decision-making; the decision to segregate suspected
COVID-19 patients to high-risk areas without seeking patients’ approval may
result in an increased risk of infection. Lastly, HCPs expressed internal
conflicts when balancing the professional duty of care against concerns
about contracting COVID-19 and spreading it to their family members. Conclusion The study highlighted ethical issues faced by HCPs in Malaysia during the
pandemic. It underscores the need for clinical ethics consultation services
in hospitals to navigate the various ethical dilemmas.
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Affiliation(s)
| | - Mark Tan Kiak Min
- Department of Medical Ethics & Law,
Faculty of Medicine, Universiti Teknologi MARA
(UiTM), Jalan Hospital, Selangor, Malaysia,Mark Tan Kiak Min, Department of Medical
Ethics & Law, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Jalan
Hospital, 47000 Sungai Buloh, Selangor, Malaysia.
| | - Shu Hui Ng
- University of Edinburgh, Edinburgh, UK,Monash University Malaysia, Bandar Sunway, Malaysia
| | - Chirk Jenn Ng
- Duke-NUS Medical School, Singapore, Singapore,SingHealth Polyclinics, Singapore, Singapore
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Lim HM, Ng CJ, Wharrad H, Lee YK, Teo CH, Lee PY, Krishnan K, Abu Hassan ZF, Yong PVC, Yap WH, Sellappans R, Ayub E, Hassan N, Shariff Ghazali S, Jahn Kassim PS, Nasharuddin NA, Idris F, Taylor M, Poussa C, Karlgren K, Stathakarou N, Mordt P, Konstantinidis S. Knowledge transfer of eLearning objects: Lessons learned from an intercontinental capacity building project. PLoS One 2022; 17:e0274771. [PMID: 36126036 PMCID: PMC9488788 DOI: 10.1371/journal.pone.0274771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/04/2022] [Indexed: 11/28/2022] Open
Abstract
Background Effective knowledge transfer of eLearning objects can hasten the adoption and dissemination of technology in teaching and learning. However, challenges exist which hinder inter-organisational knowledge transfer, particularly across continents. The ACoRD project aimed to transfer knowledge on digital learning development from UK/EU (provider) to Malaysian (receiver) higher education institutions (HEIs). This study explores the challenges encountered during the knowledge transfer process and lessons learned. Methods This is a qualitative study involving both the knowledge providers and receivers in focus group discussions (n = 25). Four focus group discussions were conducted in the early (n = 2) and mid-phase (n = 2) of the project by trained qualitative researchers using a topic guide designed to explore experiences and activities representing knowledge transfer in multi-institutional and multi-cultural settings. The interviews were audio-recorded, transcribed verbatim, and checked. The transcripts were analysed using thematic analysis. Results Five main themes emerged from this qualitative study: mismatched expectations between providers and receivers; acquiring new knowledge beyond the professional "comfort zone"; challenges in cascading newly acquired knowledge to colleagues and management; individual and organisational cultural differences; and disruption of knowledge transfer during the COVID-19 pandemic. Conclusion This study highlights the need to create a conducive platform to facilitate continuous, timely and bi-directional needs assessment and feedback; this should be done in the early phase of the knowledge transfer process. The challenges and strategies identified in this study could guide more effective knowledge transfer between organisations and countries.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Heather Wharrad
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Ping Yein Lee
- UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kuhan Krishnan
- Dean’s Office, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Phelim Voon Chen Yong
- School of Biosciences, Faculty of Health & Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Wei Hsum Yap
- School of Biosciences, Faculty of Health & Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Renukha Sellappans
- School of Pharmacy, Faculty of Health & Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Enna Ayub
- Taylor’s Digital, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Nurhanim Hassan
- Teaching and Educational Development (TED), Centre of Future Learning, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Puteri Shanaz Jahn Kassim
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurul Amelina Nasharuddin
- Department of Multimedia, Faculty of Computer Science and Information Technology, Universiti Putra Malaysia, Serdang, Malaysia
| | - Faridah Idris
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Michael Taylor
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - Cherry Poussa
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Natalia Stathakarou
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Petter Mordt
- NettOp, Department of E-Learning Development, University of Stavanger, Stavanger, Norway
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22
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Lee PY, Cheong AT, Ghazali SS, Rashid AA, Ong SC, Ong SY, Alip A, Sylvia M, Chen MF, Taib NA, Jaganathan M, Ng CJ, Teo SH. Barriers of and strategies for shared decision-making implementation in the care of metastatic breast cancer: A qualitative study among patients and healthcare professionals in an Asian country. Health Expect 2022; 25:2837-2850. [PMID: 36098241 DOI: 10.1111/hex.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision-making has been shown to improve the quality of life in metastatic breast cancer patients in high-literacy and high-resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision-making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision-making is at the forefront. This paper aims to identify (1) barriers to practising shared decision-making faced by healthcare professionals and patients and (2) strategies for implementing shared decision-making in the context of metastatic breast cancer management in Malaysia. METHODS We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi-structured in-depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. RESULTS Five main themes emerged from the study: healthcare provider-patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision-making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. CONCLUSION This study found that practising shared decision-making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision-making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider-patient barriers identified in this study. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study design, recruitment and analysis.
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Affiliation(s)
- Ping Yein Lee
- UMeHealth Unit, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Siu Ching Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Soo Ying Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Adlinda Alip
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - McCarthy Sylvia
- Clinical Service Department, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - May Feng Chen
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Universiti Malaya Cancer Research Institute, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Health Services & Systems Research, Duke NUS Medical School, Singapore, Singapore.,SingHealth Polyclinics, Singapore, Singapore
| | - Soo-Hwang Teo
- Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
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23
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Tay CL, Ng CJ. A multi-faceted intervention to improve screening of erectile dysfunction for men with diabetes mellitus in public health clinics: A pilot study. Malays Fam Physician 2022; 17:38-45. [PMID: 35949998 PMCID: PMC9357399 DOI: 10.51866/oa.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is common in men with diabetes and is associated with coronary artery disease and psychological distress. However, discussion of ED in primary care consultations is uncommon. Interventions, such as audit and feedback, mandate of management, and workshop on men's sexual health, have been proposed to improve ED screening in public health clinics. This study aimed to pilot test a multi-faceted intervention to increase ED screening among men with diabetes and to improve knowledge and confidence in ED screening among primary healthcare providers (PHPs). METHODS We conducted an interrupted time-series quasi-experimental study with PHPs at public health clinics in Perak, Malaysia from February 2019 to February 2020. Doctors, nurses, and assistant medical officers involved in diabetes care were recruited. The intervention was conducted between July and September 2019 and comprised two phases: audit and feedback, and mandate from management (phase 1), and an interactive face-to-face workshop (phase 2). The primary outcome measure was monthly ED screening rate, and the data were retrieved from health records and the clinical diabetes registry. The PHPs completed a questionnaire on ED knowledge and confidence in ED screening before and after the workshop. RESULTS The total number of attendances by patients with diabetes was 50,325 during the study period, of which 21,413 were by men. A total of 30 PHPs participated in the training workshop: 7 (23.3%) doctors, 12 (40%) medical assistants, and 11 (36.7%) nurses. The mean duration of employment at a health clinic was 7 ± 5 years. The majority of the participants were male (56.7%), Malay (80%), married (76.7%), and had no experience with working in a urology department (76.7%). There was a significant improvement in the mean knowledge score (39.0 ± 11.4 vs. 63.6 ± 6.2, p<0.001) and median confidence level in ED screening from 2 (IQR 2-3) to 4 (IQR 4-4) after the workshop (p<0.001). After phase 1, the rate of ED screening increased from a baseline of between 10.3% (February 2019) and 12.7% (June 2019) before intervention to between 15% (July 2019) and 18.9% (September 2019) and was maintained between 18% (October 2019) and 17.9% (December 2019) after phase 2. Subsequently, the ED screening rate declined from 14.6% (January 2020) to 10.9% (February 2020). CONCLUSION This study found that audit and feedback with mandate from management increased ED screening and detection rate. The workshop improved the participants' knowledge and confidence in ED screening but did not further increased ED screening. The improved practice was sustained for 6 months after the intervention, while the detection rate of ED persisted. We propose regular audit and feedback with mandate from management to sustain the practice of ED screening in men with diabetes.
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Affiliation(s)
- Chai Li Tay
- MD, MMed (Fam Med), Simpang Health Clinic, District of Larut, Matang and Selama, Taiping Perak, Ministry of Health Malaysia, Malaysia,
| | - Chirk Jenn Ng
- MBBS, MMed (Fam Med), PhD, Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Ministry of Education, Malaysia, Malaysia
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24
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Lee YK, Ng CJ, Lee PY, Tong WT, Sa'at H. Shared decision-making in Malaysia: Legislation, patient involvement, implementation and the impact of COVID-19. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2022; 171:89-92. [PMID: 35610129 PMCID: PMC9124047 DOI: 10.1016/j.zefq.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/13/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022]
Abstract
Shared decision making (SDM) activities in Malaysia began around 2010. The rise in the numbers of patients with chronic disease in Malaysia underscores a growing need for doctors to practice patient-centred care and SDM as more Malaysians come into regular contact with health decision-making scenarios. Recent guidelines for medical professionalism have emphasized that options and risks be discussed in consultations, especially for procedures with risk of adverse outcomes. Although SDM is not legally required, principles of SDM are applied in legal judgements on informed consent. Research on SDM has grown to include the adoption of patient and public involvement in research, an increased emphasis on incorporating local cultural values in SDM, and implementation of SDM in Malaysia’s health system and organizational culture. While COVID-19 hindered the progress of SDM research, one positive development was that vaccination choices heightened public consciousness about personal decisional autonomy and the need to discuss pros and cons with doctors before making a medical decision.
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Affiliation(s)
- Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping Yein Lee
- UMeHealth Unit, Dean's Office, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wen Ting Tong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hamizah Sa'at
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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25
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Tackett S, Sugarman J, Ng CJ, Kamarulzaman A, Ali J. Developing a competency framework for health research ethics education and training. J Med Ethics 2022; 48:391-396. [PMID: 33811112 PMCID: PMC8486875 DOI: 10.1136/medethics-2021-107237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 05/26/2023]
Abstract
Health research ethics (HRE) training programmes are being developed and implemented globally, often with a goal of increasing local capacity to assure ethical conduct in health-related research. Yet what it means for there to be sufficient HRE capacity is not well-defined, and there is currently no consensus on outcomes that HRE training programmes should collectively intend to achieve. Without defining the expected outcomes, meaningful evaluation of individual participants and programmes is challenging. In this article, we briefly describe the evolution of formal education in HRE, articulate the need for a framework to define outcomes for HRE training programmes, and provide guidance for developing HRE competency frameworks that define outcomes suited to their contexts. We detail critical questions for developing HRE competency frameworks using a six-step process: (1) define the purposes, intended uses and scope of the framework; (2) describe the context in which practice occurs; (3) gather data using a variety of methods to inform the competency framework; (4) translate the data into competencies that can be used in educational programmes; (5) report on the competency development process and results and (6) evaluate and update the competency framework. We suggest that competency frameworks should be feasible to develop using this process, and such efforts promise to contribute to programmatic advancement.
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Affiliation(s)
- Sean Tackett
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Adeeba Kamarulzaman
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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26
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Cheong AT, Lee PY, Ghazali SS, Rashid AA, Ng CJ, Teo CH, Rajoo Y, Ching OS, Jaganathan M, Ho BK, Teo SH. A Qualitative Exploration of the Acceptability of an Online Web Application to Promote Breast and Cervical Cancer Screening in Primary Care Settings in Malaysia. JCO Glob Oncol 2022. [DOI: 10.1200/go.22.48000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In Malaysia, breast and cervical are the most common and third most common cancers respectively. They are associated with high morbidity and mortality in women. With the rapid development of information communication technology and widespread adoption of mobile devices in low to middle-income countries, online web applications (app) could be one of the strategies to engage patients to go for screening programs. METHODS Fifteen (15) health care professionals (HCPs) and 25 patients visiting the primary care were interviewed through focus groups and in-depth interviews to determine the acceptability of an online web application to promote screening for these cancers. RESULTS Both HCPs and patients expressed that an online web app would be beneficial to the technology-savvy group such as the younger generation. However, the older-aged group could benefit from it with some assistance. The primary consideration identified is the user's information technology (IT) competency. Participants suggested that the use of easy-to-use features (eg, download method), visually easy-to-understand formats (eg, less text and more pictures, videos), and provision of support to navigate the web app may be critical to ensure good uptake of a web app on screening. Contents of the app suggested to be included were: individual risk assessment for the users of the app, benefits of screening, information addressing patients' barriers such as fear, embarrassment, logistic, and cost issues. CONCLUSION The findings of our study may be useful as a guide to developing an online web app to promote breast and cervical cancer screening.
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Affiliation(s)
- Ai Theng Cheong
- Department of Family Medicine, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Ping Yien Lee
- Department of Family Medicine, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | | | - Aneesa Abdul Rashid
- Department of Family Medicine, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Bee Kiau Ho
- Klinik Kesihatan Bandar Botanik, Port Klang, Malaysia
| | - Soo-Hwang Teo
- Cancer Research Malaysia; University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
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27
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Voo TC, Ballantyne A, Ng CJ, Cowling BJ, Xiao J, Phang KC, Kaur S, Jenarun G, Kumar V, Lim JM, Tun ZM, Wong NCB, Tam CC. Public acceptability of COVID-19 control measures in Singapore, Hong Kong, and Malaysia: A cross-sectional survey. Int J Infect Dis 2022; 120:51-58. [PMID: 35430376 PMCID: PMC9007749 DOI: 10.1016/j.ijid.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/11/2022] [Accepted: 04/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Several countries have implemented control measures to limit SARS-CoV-2 spread, including digital contact tracing, digital monitoring of quarantined individuals, and testing of travelers. These raise ethical issues around privacy, personal freedoms, and equity. However, little is known regarding public acceptability of these measures. Methods In December 2020, we conducted a survey among 3635 respondents in Singapore, Hong Kong, and Malaysia to understand public perceptions on the acceptability of COVID-19 control measures. Findings Hong Kong respondents were much less supportive of digital contact tracing and monitoring devices than those in Malaysia and Singapore. Around three-quarters of Hong Kong respondents perceived digital contact tracing as an unreasonable restriction of individual freedom; <20% trusted that there were adequate local provisions preventing these data being used for other purposes. This was the opposite in Singapore, where nearly 3/4 of respondents agreed that there were adequate data protection rules locally. In contrast, only a minority of Hong Kong respondents viewed mandatory testing and vaccination for travelers as unreasonable infringements of privacy or freedom. Less than 2/3 of respondents in all territories were willing to be vaccinated against COVID-19, with a quarter of respondents undecided. However, support for differential travel restrictions for vaccinated and unvaccinated individuals was high in all settings. Interpretation Our findings highlight the importance of sociopolitical context in public perception of public health measures and emphasize the need to continually monitor public attitudes toward such measures to inform implementation and communication strategies.
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Affiliation(s)
- Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Angela Ballantyne
- Department of Primary Health Care and General Practice, University of Otago, Otago, New Zealand
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Jingyi Xiao
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kean Chang Phang
- University of Malaya Medical Centre, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Sharon Kaur
- Faculty of Law, University of Malaya, Kuala Lumpur Malaysia
| | - Grazele Jenarun
- Medical Research Ethics Committee, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Vishakha Kumar
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jane Mingjie Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Zaw Myo Tun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nigel Chong Boon Wong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; London School of Hygiene & Tropical Medicine, London, England, United Kingdom.
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28
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Kong Lee Y, Jenn Ng C, Reza Syahirah M, Malik Tun Firzara A, Kian Chiew T, Yein Lee P, Abdullah A, Chin Ai Lee C, Khaizura K, Yamin Ahmad M, Zahir Ahmad M. Effectiveness of a web-based, electronic medical records-integrated patient agenda tool to improve doctor-patient communication in primary care consultations: a pragmatic cluster-randomized controlled trial study. Int J Med Inform 2022; 162:104761. [DOI: 10.1016/j.ijmedinf.2022.104761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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29
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Lee YK, Wattanapisit A, Ng CJ, Boey CCM, Ahmad Kamar A, Choo YM, Hong JSS, Cheah FC, Tang SF, Poh BK, Chongviriyaphan N, Siwarom S, Visuthranukul C, Koletzko B. Tailoring an online breastfeeding course for Southeast Asian paediatric trainees- A qualitative study of user experience from Malaysia and Thailand. BMC Med Educ 2022; 22:209. [PMID: 35351116 PMCID: PMC8960711 DOI: 10.1186/s12909-022-03284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study explored the user experiences of paediatric postgraduate trainees in Malaysia and Thailand in using a 2 h and 15 min online module for breastfeeding developed for Southeast Asia, which was adapted from existing European online modules for European and German Continuing Medical Education (CME) credits. METHODS A qualitative study using focus group discussions (FGDs) was conducted with paediatric postgraduate trainees who used an online English-language breastfeeding module in two Thai universities (May 2020, done online) and two Malaysian universities (Sept- Nov 2019, in-person). FGDs explored module usability and utility. Sessions were transcribed verbatim and analysed thematically. The process of coding was done collaboratively by Thai and Malaysian researchers. RESULTS Twenty Six resident trainees participated (Thai, n = 13; Malaysian, n = 13). Ages ranged from 29-34 years old, with 21 females. Nineteen participants had never used online learning modules prior to this. Participants took between 1 to 5 sessions to complete the breastfeeding module. Four themes emerged from their experience. 1) The online learning module was more engaging and detailed than previous lectures, courses and/or books, but lacked hands-on training. 2) Using an online platform facilitated learning as eased navigation and resource searching, however, problems were encountered navigating the module on some devices. 3) Learners preferred less words and more graphics, as this helped them capture key messages. 4) Regionally tailored content elicited a mixed reaction from participants. CONCLUSIONS Users found that the adapted module compared favourably with previous learning experiences. However, online learning modules lack hands-on training, and implementation should ideally incorporate a mix of both. Consideration of device diversity and preferences for how content was adapted for local settings are needed for tailoring.
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Affiliation(s)
- Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Azanna Ahmad Kamar
- Department of Paediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yao Mun Choo
- Department of Paediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Fook Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Swee Fong Tang
- Specialist Children's Hospital, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Bee Koon Poh
- Department of Nutrition & Dietetics, Faculty of Health Sciences, Universiti Kebangsaaan Malaysia, Kuala Lumpur, Malaysia
| | - Nalinee Chongviriyaphan
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirinapa Siwarom
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chonnikant Visuthranukul
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Berthold Koletzko
- Division of Metabolic Diseases and Nutritional Medicine, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
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30
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Jalil NB, Lee PY, Nor Afiah MZ, Abdullah KL, Azizi FNSM, Rassip NNSA, Ong TA, Ng CJ, Lee YK, Cheong AT, Razack AH, Saad M, Alip A, Malek R, Sundram M, Omar S, Sathiyananthan JR, Kumar P. Effectiveness of Decision Aid in Men with Localized Prostate Cancer: a Multicenter Randomized Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country. J Cancer Educ 2022; 37:169-178. [PMID: 32564251 DOI: 10.1007/s13187-020-01801-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients' knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients' knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.
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Affiliation(s)
- N B Jalil
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - P Y Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
| | - M Z Nor Afiah
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - K L Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - F N S Mohd Azizi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - N N S Abdul Rassip
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - T A Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - C J Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Y K Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A T Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - A H Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M Saad
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Alip
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Malek
- Unit of Urology, Selayang Hospital, Selangor, Malaysia
| | - M Sundram
- Unit of Urology, General Hospital of Kuala Lumpur, Kuala Lumpur, Malaysia
| | - S Omar
- Unit of Urology, Johor Bahru Hospital, Johor Bahru, Johor, Malaysia
| | | | - P Kumar
- Department of Surgery, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Lim HM, Wong SS, Yip KC, Chang FWS, Chin AJZ, Teo CH, Abdullah A, Ng CJ. Online health information-seeking behaviour of patients attending a primary care clinic in Malaysia: a cross-sectional study. Fam Pract 2022; 39:38-45. [PMID: 34423368 DOI: 10.1093/fampra/cmab099] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The internet has become a common source of health information; however, little is known about online health information-seeking behaviour (HISB) among patients in low- and middle-income countries (LMICs). OBJECTIVES This study aimed to determine the prevalence of online health information-seeking and its associated factors among patients in primary care in Malaysia. We also examined the reasons for, and the sources of, online health information-seeking, patients' level of trust in the information found and what the information was used for. METHODS A cross-sectional study using a self-administered questionnaire was conducted on patients who attended a primary care clinic. The questionnaire included the use of the internet to seek health information, sources and types of health information, eHealth literacy, patients' trust in online information, and how patients appraise and use online health information. RESULTS Out of 381 patients in this study, 54.7% (n = 208) used the internet to search for health information. Patients mainly sought information via Google (96.2%) and the most common websites that they visited were Wikipedia (45.2%) and MyHEALTH (37.5%). Higher levels of education, longer duration of internet use, and higher eHealth literacy were significantly associated with online HISB. Patients' trust in websites (45.6%) and social media (20.7%) was low when compared to trust in healthcare professionals (87.9%). Only 12.9% (n = 22) of patients had discussed online health information with their doctors. CONCLUSION Online HISB was common among primary care patients; however, their eHealth literacy was low, with suboptimal appraisal skills to evaluate the accuracy of online health information.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Swee Shiuan Wong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Chun Yip
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Felicia Wen Si Chang
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adrian Jian Zhi Chin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abdullah A, Liew SM, Salim H, Ng CJ, Chinna K. Correction: Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS One 2022; 17:e0261430. [PMID: 34982790 PMCID: PMC8726497 DOI: 10.1371/journal.pone.0261430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lim HM, Dunn AG, Lim JR, Abdullah A, Ng CJ. Association between online health information-seeking and medication adherence: A systematic review and meta-analysis. Digit Health 2022; 8:20552076221097784. [PMID: 35586836 PMCID: PMC9109497 DOI: 10.1177/20552076221097784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background The evidence of the impact of online health information-seeking (OHIS) on
health outcomes has been conflicting. OHIS is increasingly recognised as a
factor influencing health behaviour but the impact of OHIS on medication
adherence remains unclear. Objectives We conducted a systematic review and meta-analysis to examine the
associations between OHIS and medication adherence. Methods We searched Medline, Embase, Web of Science, Scopus, CINAHL and Psychology
and Behavioural Science Collection for studies published up to December
2020. The inclusion criteria were studies that reported the associations of
OHIS and medication adherence, quantitative design, reported primary data
only, related to any health condition where medications are used and
conducted on patients either in clinical or community settings. A
meta-analysis was used to examine the association between OHIS and
medication adherence. Results A total of 17 studies involving 24,890 patients were included in this review.
The study designs and results were mixed. In the meta-analysis, there was no
significant association (n = 7, OR 1.356, 95% CI 0.793-2.322, p = 0.265), or
correlation (n = 4, r = -0.085, 95% CI −0.572-0.446, p = 0.768) between OHIS
and medication adherence. In the sub-group analysis of people living with
HIV/AIDS, OHIS was associated with better medication adherence (OR 1.612,
95% CI 1.266-2.054, p < 0.001). Conclusions The current evidence of an association between OHIS and medication adherence
is inconclusive. This review highlights methodological issues on how to
measure OHIS objectively and calls for in-depth exploration of how OHIS
affects health decisions and behaviour.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jing Ran Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Duke-NUS Medical School, Singapore
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Wong SS, Lim HM, Chin AJZ, Chang FWS, Yip KC, Teo CH, Abdullah A, Ng CJ. eHealth literacy of patients attending a primary care clinic in Malaysia and its associated factors: A cross-sectional study. Digit Health 2022; 8:20552076221135392. [PMID: 36420318 PMCID: PMC9677303 DOI: 10.1177/20552076221135392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND People are overloaded with online health information (OHI) of variable quality. eHealth literacy is important for people to acquire and appraise reliable information to make health-related decisions. While eHealth literacy is widely studied in developed countries, few studies have been conducted among patients in low- and middle-income countries (LMICs). OBJECTIVE We aimed to determine the level of eHealth literacy in patients attending a primary care clinic in Malaysia and its associated factors. METHODS A cross-sectional study using a self-administered questionnaire was conducted in an urban primary care clinic. We used a systematic random sampling method to select patients aged 18 years and above who attended the clinic. The eHealth literacy scale (eHEALS) was used to measure eHealth literacy. RESULTS A total of 381 participants were included. The mean eHEALS was 24.4 ± 7.6. The eHEALS statements related to skills in appraising OHI were scored lower than statements related to looking for online resources. Higher education level of attending upper secondary school (AOR 2.53, 95% CI 1.05-6.11), tertiary education (AOR 4.05, 95% CI 1.60-10.25), higher monthly household income of >US$470 (AOR 1.95, 95% CI 1.07-3.56), and those who had sought OHI in the past month (AOR 1.95, 95% CI 1.13-3.36) were associated with a higher eHealth literacy level. CONCLUSIONS This study found a low eHealth literacy level among primary care patients in Malaysia. While the patients were confident in searching for OHI, they lacked skills in appraising them. Our findings inform the interventions for improving eHealth literacy in LMICs, especially educating the public about OHI appraisal.
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Affiliation(s)
- Swee Shiuan Wong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adrian Jian Zhi Chin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Felicia Wen Si Chang
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Chun Yip
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Duke-NUS Medical School, Singapore
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Lee YK, Ng CJ, Sim JH, Firdaus A, Foong CC, Hong WH, Sanusi J, Lim AJH, Boey CCM. Barriers to effective research supervision in clinical specialist training: Experience from a medical school in Malaysia. Malays Fam Physician 2021; 16:77-86. [PMID: 34938395 PMCID: PMC8680945 DOI: 10.51866/oa1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION A compulsory research component is becoming increasingly common for clinical residents. However, integrating research into a busy clinical training schedule can be challenging. This study aimed to explore barriers to research supervision in specialist training programmes from the perspectives of clinical supervisors and trainees at a Malaysian university hospital. METHODS Qualitative interviews and focus group discussions were conducted (December 2016 to July 2017) with clinical supervisors (n=11) and clinical trainees (n=26) utilising a topic guide exploring institutional guidelines, research culture and supervisor-student roles. Interviews were transcribed verbatim and analysed thematically to identify barriers to research supervision. RESULTS Supervisors and trainees from 11 out of 18 departments participated. Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. Among the reasons identified included a lack of supervisory access due to the nature of clinical rotations and placements, clashing training priorities (clinical vs research) that discouraged trainees and supervisors from engaging in research, poor research expertise and experience among clinical supervisors hampering high-quality supervision, and a frustrating lack of clear standards between the various parties involved in research guidance and examination. CONCLUSION Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. This was not only an issue of resource limitation since questions regarding clinical priorities and unclear research standards emerged. Thus, institutional coordinators need to set clear standards and provide adequate training to make research meaningful and achievable for busy clinical supervisors and trainees.
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Affiliation(s)
- Yew Kong Lee
- BA, PhD, Department of Primary Care Medicine, Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia,
| | - Chirk Jenn Ng
- MBBS, MMed(Family Medicine), PhD Department of Primary Care Medicine, Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia
| | - Joong Hiong Sim
- BSc (Hons), LLB (Hons), MEd, PhD Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia
| | - Amira Firdaus
- BSc, MA, PhD, Department of Media Studies, Faculty of Arts & Social Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Chan Choong Foong
- BScEd, PhD, Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia
| | - Wei Han Hong
- PhD, Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia
| | - Junedah Sanusi
- PhD, International Institute of Public Policy & Management (Inpuma), University of Malaya, Kuala Lumpur, Malaysia
| | - Adrian Jia Hwa Lim
- MBBS, Department of Primary Care Medicine, Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher Chiong Meng Boey
- MBBS, DCH, MD, PhD, FRCPCH, FRCP, Department of Paediatrics, Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia
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Ng TC, Teo CH, Toh JY, Dunn AG, Ng CJ, Ang TF, Abdullah A, Syed A, Lim HM, Yin K, Liew CS. Factors influencing healthcare seeking in patients with dengue: systematic review. Trop Med Int Health 2021; 27:13-27. [PMID: 34655508 DOI: 10.1111/tmi.13695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Delays in seeking healthcare for dengue are associated with poor health outcomes. Despite this, the factors influencing such delays remain unclear, rendering interventions to improve healthcare seeking for dengue ineffective. This systematic review aimed to synthesise the factors influencing healthcare seeking of patients with dengue and form a comprehensive framework. METHODS This review included both qualitative and quantitative studies. Studies were obtained by searching five databases, contacting field experts and performing backward reference searches. The best-fit meta-synthesis approach was used during data synthesis, where extracted data were fitted into the social-ecological model. Sub-analyses were conducted to identify the commonly reported factors and their level of statistical significance. RESULTS Twenty studies were selected for meta-synthesis. Eighteen factors influencing healthcare seeking in dengue were identified and categorised under four domains: individual (11 factors), interpersonal (one factor), organisational (four factors) and community (two factors). The most reported factors were knowledge of dengue, access to healthcare, quality of health service and resource availability. Overall, more barriers to dengue health seeking than facilitators were found. History of dengue infection and having knowledge of dengue were found to be ambiguous as they both facilitated and hindered dengue healthcare seeking. Contrary to common belief, women were less likely to seek help for dengue than men. CONCLUSIONS The factors affecting dengue healthcare-seeking behaviour are diverse, can be ambiguous and are found across multiple social-ecological levels. Understanding these complexities is essential for the development of effective interventions to improve dengue healthcare-seeking behaviour.
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Affiliation(s)
- Tze Chang Ng
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Jia Yong Toh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chirk Jenn Ng
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Tan Fong Ang
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Ayeshah Syed
- Department of English Language, Faculty of Languages & Linguistics, Universiti Malaya, Malaysia
| | - Hooi Min Lim
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Kathleen Yin
- Centre of Health Informatics, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Chee Sun Liew
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia.,University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia
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Lim HM, Abdullah A, Ng CJ, Teo CH, Valliyappan IG, Abdul Hadi H, Ng WL, Noor Azhar AM, Chiew TK, Liew CS, Chan CS. Utility and usability of an automated COVID-19 symptom monitoring system (CoSMoS) in primary care during COVID-19 pandemic: A qualitative feasibility study. Int J Med Inform 2021; 155:104567. [PMID: 34536808 PMCID: PMC8420087 DOI: 10.1016/j.ijmedinf.2021.104567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/27/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
Background COVID-19 telemonitoring applications have been developed and used in primary care to monitor patients quarantined at home. There is a lack of evidence on the utility and usability of telemonitoring applications from end-users’ perspective. Objectives This study aimed to evaluate the feasibility of a COVID-19 symptom monitoring system (CoSMoS) by exploring its utility and usability with end-users. Methods This was a qualitative study using in-depth interviews. Patients with suspected COVID-19 infection who used CoSMoS Telegram bot to monitor their COVID-19 symptoms and doctors who conducted the telemonitoring via CoSMoS dashboard were recruited. Universal sampling was used in this study. We stopped the recruitment when data saturation was reached. Patients and doctors shared their experiences using CoSMoS, its utility and usability for COVID-19 symptoms monitoring. Data were coded and analysed using thematic analysis. Results A total of 11 patients and 4 doctors were recruited into this study. For utility, CoSMoS was useful in providing close monitoring and continuity of care, supporting patients’ decision making, ensuring adherence to reporting, and reducing healthcare workers’ burden during the pandemic. In terms of usability, patients expressed that CoSMoS was convenient and easy to use. The use of the existing social media application for symptom monitoring was acceptable for the patients. The content in the Telegram bot was easy to understand, although revision was needed to keep the content updated. Doctors preferred to integrate CoSMoS into the electronic medical record. Conclusion CoSMoS is feasible and useful to patients and doctors in providing remote monitoring and teleconsultation during the COVID-19 pandemic. The utility and usability evaluation enables the refinement of CoSMoS to be a patient-centred monitoring system.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia; University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Chirk Jenn Ng
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Indra Gayatri Valliyappan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Haireen Abdul Hadi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Abdul Muhaimin Noor Azhar
- Department of Emergency Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Thiam Kian Chiew
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Software Engineering, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chee Sun Liew
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Computer System & Technology, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chee Seng Chan
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Artificial Intelligence, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
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38
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Joachimdass RJ, Subramaniam K, Sit NW, Lim YM, Teo CH, Ng CJ, Yusof AS, Loganathan A. Self-management using crude herbs and the health-related quality of life among adult patients with hypertension living in a suburban setting of Malaysia. PLoS One 2021; 16:e0257336. [PMID: 34506588 PMCID: PMC8432735 DOI: 10.1371/journal.pone.0257336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine the prevalence of crude herbs' use in the self-management of hypertension and the health-related quality of life (HRQOL) in patients with hypertension. METHODS This cross-sectional study was performed among patients with hypertension attending a government health clinic. Socio-demographic characteristics, lifestyle modifications, medical history and predictors of crude herbs users were obtained. The diversity of crude herbs used was assessed using a modified international complementary and alternative medicine questionnaire (I-CAM-Q) and the HRQOL was assessed using the SF36 instrument. RESULTS Out of the 294 patients recruited, 52.4% were female, 41.5% were Malay and 38.8% were within the 60 to69 age category. The prevalence of crude herbs users was 30.6% and the most common herbs used were pegaga (Centella asiatica), peria (Momordica charantia) and betik (Carica papaya). Using the regression analysis, significantly higher odds of using crude herbs are noted among Malay or Indian patients who have these characteristics: attained secondary education, experienced falls or muscle pain, and had systolic blood pressure of more than 140 mmHg. There was no significant difference in HRQOL domains between the crude herb users and non-users (p>0.05). CONCLUSION Besides taking allopathic medications, certain patients with hypertension use crude herbs as a form of self-management. Although patients are adamant about integrating crude herbs as a form of self-management, the effects of doing so have not been properly investigated. This implies that the healthcare staff members need to communicate with the patients regarding the use of crude herbs together with conventional drugs.
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Affiliation(s)
| | | | - Nam Weng Sit
- Faculty of Science, Universiti Tunku Abdul Rahman, Kampar, Malaysia
| | - Yang Mooi Lim
- Department of Pre-Clincal Science, Universiti Tunku Abdul Rahman, Sungai Long, Malaysia
- Centre for Cancer Research, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Chin Hai Teo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Shunnmugam B, Ng CJ, Aishah Mohd Taib N, Chinna K. Validation of the Malay, English, and Chinese Translations of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in Breast Cancer Patients Making Treatment Decisions. Asia Pac J Public Health 2021; 33:914-922. [PMID: 34467767 DOI: 10.1177/10105395211036625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to test the psychometric properties of the Malay, English, and Chinese 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in breast cancer patients making treatment decisions. The original German SDM-Q-9 was translated to Malay using the back-translation method. A total of 222 newly diagnosed breast cancer patients making treatment decisions were sampled conveniently from three breast clinics between August 2015 and February 2016. A total of 66 patients answered the SDM-Q-9 in Malay, 87 in English, and 69 in Chinese. Data were analyzed using SPSS and AMOS software. SDM-Q-9 demonstrated good reliability in the three translations. All the items correlated well except for Item 1 in English. The factor loadings were within acceptable range except for Item 1 in Malay, Items 1 and 2 in English, and Items 7 and 9 in Chinese SDM-Q-9. However, no items were deleted in accordance with experts' opinions and the previous SDM-Q-9 validation studies. The Malay, English, and Chinese SDM-Q-9 demonstrated good reliability and validity.
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Affiliation(s)
- Bairave Shunnmugam
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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40
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Wattanapisit A, Poomiphak Na Nongkhai M, Hemarachatanon P, Huntula S, Amornsriwatanakul A, Paratthakonkun C, Ng CJ. What Elements of Sport and Exercise Science Should Primary Care Physicians Learn? An Interdisciplinary Discussion. Front Med (Lausanne) 2021; 8:704403. [PMID: 34422861 PMCID: PMC8371467 DOI: 10.3389/fmed.2021.704403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Marisa Poomiphak Na Nongkhai
- Department of Sport and Exercise Science, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
| | - Poramet Hemarachatanon
- Department of Sport and Exercise Science, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
| | - Soontaraporn Huntula
- Department of Sport and Exercise Science, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
| | - Areekul Amornsriwatanakul
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand.,School of Human Sciences (Sport Science, Exercise, and Health), University of Western Australia, Perth, WA, Australia
| | | | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Lim HM, Ng CJ, Teo CH, Lee PY, Kassim PSJ, Nasharuddin NA, Yong PVC, Sellappans R, Yap WH, Lee YK, Abu Hassan ZF, Krishnan K, Ghazali SS, Idris F, Hassan N, Ayub E, Konstantinidis S, Taylor M, Poussa C, Karlgren K, Stathakarou N, Mordt P, Nilsen AT, Wharrad H. Prioritising topics for developing e-learning resources in healthcare curricula: A comparison between students and educators using a modified Delphi survey. PLoS One 2021; 16:e0253471. [PMID: 34166432 PMCID: PMC8224897 DOI: 10.1371/journal.pone.0253471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background Engaging students in the e-learning development process enhances the effective implementation of e-learning, however, students’ priority on the topics for e-learning may differ from that of the educators. This study aims to compare the differences between the students and their educators in prioritising the topics in three healthcare curricula for reusable e-learning object (RLO) development. Method A modified Delphi study was conducted among students and educators from University Malaya (UM), Universiti Putra Malaysia (UPM) and Taylor’s University (TU) on three undergraduate programmes. In Round 1, participants were asked to select the topics from the respective syllabi to be developed into RLOs. Priority ranking was determined by using frequencies and proportions. The first quartile of the prioritised topics was included in Round 2 survey, which the participants were asked to rate the level of priority of each topic using a 5-point Likert scale. The mean score of the topics was compared between students and educators. Result A total of 43 educators and 377 students participated in this study. For UM and TU Pharmacy, there was a mismatch in the prioritised topics between the students and educators. For UPM, both the educators and students have prioritised the same topics in both rounds. To harmonise the prioritisation of topics between students and educators for UM and TU Pharmacy, the topics with a higher mean score by both the students and educators were prioritised. Conclusion The mismatch in prioritised topics between students and educators uncovered factors that might influence the prioritisation process. This study highlighted the importance of conducting needs assessment at the beginning of eLearning resources development.
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Affiliation(s)
- Hooi Min Lim
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Chin Hai Teo
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ping Yein Lee
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - Puteri Shanaz Jahn Kassim
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurul Amelina Nasharuddin
- Faculty of Computer Science and Information Technology, Department of Multimedia, Universiti Putra Malaysia, Serdang, Malaysia
| | - Phelim Voon Chen Yong
- Faculty of Health & Medical Sciences, School of Biosciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Renukha Sellappans
- Faculty of Health & Medical Sciences, School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Wei Hsum Yap
- Faculty of Health & Medical Sciences, School of Biosciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Yew Kong Lee
- Faculty of Medicine, Department of Primary Care Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Kuhan Krishnan
- Faculty of Medicine, Medical Research and Development Unit, University Malaya, Kuala Lumpur, Malaysia
| | - Sazlina Shariff Ghazali
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - Faridah Idris
- Faculty of Medicine and Health Sciences, Department of Pathology, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurhanim Hassan
- E-Learning Academy, INTELLECT, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | - Enna Ayub
- E-Learning Academy, INTELLECT, Taylor’s University, Subang Jaya, Selangor, Malaysia
| | | | - Michael Taylor
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - Cherry Poussa
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Sweden
| | - Natalia Stathakarou
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Sweden
| | - Petter Mordt
- NettOp, Department of E-Learning Development, University of Stavanger, Stavanger, Norway
| | - Arne Thomas Nilsen
- NettOp, Department of E-Learning Development, University of Stavanger, Stavanger, Norway
| | - Heather Wharrad
- School of Health Sciences, University of Nottingham, Nottingham, England
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Lim HM, Dunn AG, Muhammad Firdaus Ooi S, Teo CH, Abdullah A, Woo WJ, Ng CJ. mHealth adoption among primary care physicians in Malaysia and its associated factors: a cross-sectional study. Fam Pract 2021; 38:210-217. [PMID: 32968795 DOI: 10.1093/fampra/cmaa103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND mHealth apps potentially improve health care delivery and patient outcomes, but the uptake of mHealth in primary care is challenging, especially in low-middle-income countries. OBJECTIVE To measure factors associated with mHealth adoption among primary care physicians (PCPs) in Malaysia. METHODS A cross-sectional study using a self-administered questionnaire was conducted among PCPs. The usage of mHealth apps by the PCPs has divided into the use of mHealth apps to support PCPs' clinical work and recommendation of mHealth apps for patient's use. Factors associated with mHealth adoption were analysed using multivariable logistic regression. RESULTS Among 217 PCPs in the study, 77.0% used mHealth apps frequently for medical references, 78.3% medical calculation and 30.9% interacting with electronic health records (EHRs). Only 22.1% of PCPs frequently recommended mHealth apps to patients for tracking health information, 22.1% patient education and 14.3% use as a medical device. Performance expectancy and facilitating conditions were associated with mHealth use for medical references. Family medicine trainees, working in a government practice and performance expectancy were the facilitators for the use of mHealth apps for medical calculation. Internet connectivity, performance expectancy and use by colleagues were associated with the use of mHealth with EHR. Performance expectancy was associated with mHealth apps' recommendation to patients to track health information and provide patient education. CONCLUSIONS PCPs often used mHealth apps to support their clinical work but seldom recommended mHealth apps to their patients. Training for PCPs is needed on the appraisal and knowledge of the mHealth apps for patient use.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam G Dunn
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Chin Hai Teo
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wing Jun Woo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- University of Malaya eHealth Initiative (UMeHI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
Making healthcare decisions collaboratively between patients and doctors can be challenging in primary care, as clinical encounters are often short. Conflicts between patients and doctors during the decision-making process may affect both patient and doctor satisfaction and result in medico-legal consequences. With the increasing recognition of the importance of patient empowerment, shared decision making (SDM) can serve as a practical consultation model for primary care doctors (PCDs) to guide patients in making informed healthcare choices. Although more research is needed to find effective ways to implement SDM in the real world, the 6-step approach presented in this paper can guide PCDs to practise SDM in their daily practice. Implementation of SDM can be further enhanced by incorporating SDM training into undergraduate and postgraduate curricula and using evidence-based tools such as patient decision aids.
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Affiliation(s)
- Chirk Jenn Ng
- MBBS, MMed Family Med, PhD, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
| | - Ping Yein Lee
- MBBS, MMed Family Med, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Lim HM, Teo CH, Ng CJ, Chiew TK, Ng WL, Abdullah A, Abdul Hadi H, Liew CS, Chan CS. An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study. JMIR Med Inform 2021; 9:e23427. [PMID: 33600345 PMCID: PMC7919845 DOI: 10.2196/23427] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/05/2020] [Accepted: 01/16/2021] [Indexed: 12/15/2022] Open
Abstract
Background During the COVID-19 pandemic, there was an urgent need to develop an automated COVID-19 symptom monitoring system to reduce the burden on the health care system and to provide better self-monitoring at home. Objective This paper aimed to describe the development process of the COVID-19 Symptom Monitoring System (CoSMoS), which consists of a self-monitoring, algorithm-based Telegram bot and a teleconsultation system. We describe all the essential steps from the clinical perspective and our technical approach in designing, developing, and integrating the system into clinical practice during the COVID-19 pandemic as well as lessons learned from this development process. Methods CoSMoS was developed in three phases: (1) requirement formation to identify clinical problems and to draft the clinical algorithm, (2) development testing iteration using the agile software development method, and (3) integration into clinical practice to design an effective clinical workflow using repeated simulations and role-playing. Results We completed the development of CoSMoS in 19 days. In Phase 1 (ie, requirement formation), we identified three main functions: a daily automated reminder system for patients to self-check their symptoms, a safe patient risk assessment to guide patients in clinical decision making, and an active telemonitoring system with real-time phone consultations. The system architecture of CoSMoS involved five components: Telegram instant messaging, a clinician dashboard, system administration (ie, back end), a database, and development and operations infrastructure. The integration of CoSMoS into clinical practice involved the consideration of COVID-19 infectivity and patient safety. Conclusions This study demonstrated that developing a COVID-19 symptom monitoring system within a short time during a pandemic is feasible using the agile development method. Time factors and communication between the technical and clinical teams were the main challenges in the development process. The development process and lessons learned from this study can guide the future development of digital monitoring systems during the next pandemic, especially in developing countries.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Dean's Office, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thiam Kian Chiew
- eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Software Engineering, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Haireen Abdul Hadi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Sun Liew
- eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Computer System and Technology, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Seng Chan
- eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
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Tong WT, Lee YK, Ng CJ, Lee PY. Factors influencing implementation of an insulin patient decision aid at public health clinics in Malaysia: A qualitative study. PLoS One 2020; 15:e0244645. [PMID: 33378349 PMCID: PMC7773191 DOI: 10.1371/journal.pone.0244645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many patient decision aids (PDAs) are developed in academic settings by academic researchers. Academic settings are different from public health clinics where the focus is on clinical work. Thus, research on implementation in public health settings will provide insights to effective implementation of PDA in real-world settings. This study explores perceived factors influencing implementation of an insulin PDA in five public health clinics. METHODS This study adopted a comparative case study design with a qualitative focus to identify similarities and differences of the potential barriers and facilitators to implementing the insulin PDA across different sites. Focus groups and individual interviews were conducted with 28 healthcare providers and 15 patients from five public health clinics under the Ministry of Health in Malaysia. The interviews were transcribed verbatim and analysed using the thematic approach. RESULTS Five themes emerged which were: 1) time constraint; 2) PDA costs; 3) tailoring PDA use to patient profile; 4) patient decisional role; and 5) leadership and staff motivation. Based on the interviews and drawing on observations and interview reflection notes, time constraint emerged as the common prominent factor that cut across all the clinics, however, tailoring PDA use to patient profile; patient decisional role; leadership and staff motivation varied due to the distinct challenges faced by specific clinics. Among clinics from semi-urban areas with more patients from limited education and lower socio-economic status, patients' ability to comprehend the insulin PDA and their tendency to rely on their doctors and family to make health decisions were felt to be a prominent barrier to the insulin PDA implementation. Staff motivation appeared to be stronger in most of the clinics where specific time was allocated to diabetes team to attend to diabetes patients and this was felt could be a potential facilitator, however, a lack of leadership might affect the insulin PDA implementation even though a diabetes team is present. CONCLUSIONS This study found time constraint as a major potential barrier for PDA implementation and effective implementation of the insulin PDA across different public health clinics would depend on leadership and staff motivation and, the need to tailor PDA use to patient profile. To ensure successful implementation, implementers should avoid a 'one size fits all' approach when implementing health innovations.
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Affiliation(s)
- Wen Ting Tong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping Yein Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
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46
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Abdullah A, Ng CJ, Liew SM, Ambigapathy S, V P, Chinna K. Prevalence of limited health literacy and its associated factors in patients with type 2 diabetes mellitus in Perak, Malaysia: a cross-sectional study. BMJ Open 2020; 10:e039864. [PMID: 33191262 PMCID: PMC7668359 DOI: 10.1136/bmjopen-2020-039864] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 10/13/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Limited health literacy in patients with type 2 diabetes mellitus (T2DM) led to poorer diabetes knowledge, less medication adherence and increased healthcare cost. The purpose of this paper was to report the prevalence of limited health literacy in patients with T2DM and to identify factors that are associated with it. DESIGN A cross-sectional study was conducted from January to March 2018; data on patients' sociodemographic characteristics, diabetes knowledge, perceived social support and health literacy level were collected. Health literacy level was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q47). SETTING Patients were recruited from four primary care clinics in Perak, Malaysia. PARTICIPANTS Adult patients diagnosed with T2DM who attended the study clinics during the study period. PRIMARY OUTCOME VARIABLE Patients with HLS-EU-Q47 General Index of ≤33 points were classified as having limited health literacy. RESULTS The prevalence of limited health literacy was 65.3% (n=279). In bivariate analysis, patients' ethnicity (p=0.04), highest education level (p<0.001), monthly income (p=0.003), having health insurance (p=0.007), English language fluency (p<0.001), Malay language fluency (p=0.021), attending diabetes education sessions (p<0.001), perceived social support (p<0.001) and diabetes knowledge (p=0.019) were factors associated with limited health literacy. In logistic regression, not being fluent in English was associated with limited health literacy (OR=2.36, 95% CI 1.30 to 4.30) whereas having high perceived social support (OR=0.52, 95% CI 0.40 to 0.69) and having attended diabetes education sessions (OR=0.42, 95% CI 0.27 to 0.68) were associated with adequate health literacy. CONCLUSION The prevalence of limited health literacy is high among patients with T2DM in Perak, Malaysia. Strategies to improve health literacy in these patients must consider the influences of English fluency, attendance at diabetes education sessions and social support, and may need to adopt a universal approach to addressing limited health literacy.
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Affiliation(s)
- Adina Abdullah
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Paranthaman V
- Health Clinic Greentown, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Kuala Lumpur, Malaysia
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47
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Ng CJ. We need a research plan. Malays Fam Physician 2020; 15:1-2. [PMID: 33329857 PMCID: PMC7735886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Lee YK, Praveena KA, Woo YL, Ng CJ. Coping Strategies among Malaysian Women with Recurrent Ovarian Cancer: A Qualitative Study. Asia Pac J Oncol Nurs 2020; 8:40-45. [PMID: 33426188 PMCID: PMC7785070 DOI: 10.4103/apjon.apjon_38_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/27/2020] [Indexed: 11/08/2022] Open
Abstract
Objective: Ovarian cancer is one of the most common cancers among Malaysian women with high recurrence. Patients with recurrence are prone to emotional distress and are forced to cope with poor prognosis. This study aimed to explore the coping strategies employed by women with recurrent ovarian cancer in Malaysia, a developing multicultural country in Asia. Methods: This was a qualitative study with patients diagnosed with recurrent ovarian cancer and receiving chemotherapy at a hospital gynecologic day-care unit. In-depth individual interviews were conducted with patients to explore how they coped with recurrence of ovarian cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results: The participants' (n = 10) age range was 52–84 years, the three most common ethnic backgrounds were represented (Malay, Chinese, and Indian), and most of the patients were well educated. All patients were on chemotherapy. Six coping strategies were identified: (1) maintaining a mindset of hopefulness, (2) avoidance of information, (3) accepting their condition, (4) seeking spiritual help, (5) relying on family for support, and (6) coping with financial costs. Conclusions: Coping strategies employed during ovarian cancer recurrence in this setting were rarely based on the accurate information appraisal, but rather on the individual emotion and personal beliefs.
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Affiliation(s)
- Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K Asokan Praveena
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kassai R, van Weel C, Flegg K, Tong SF, Han TM, Noknoy S, Dashtseren M, Le An P, Ng CJ, Khoo EM, Noh KM, Lee MC, Howe A, Goodyear-Smith F. Priorities for primary health care policy implementation: recommendations from the combined experience of six countries in the Asia-Pacific. Aust J Prim Health 2020; 26:351-357. [PMID: 32746962 DOI: 10.1071/py19194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/31/2020] [Indexed: 11/23/2022]
Abstract
Primary health care is essential for equitable, cost-effective and sustainable health care. It is the cornerstone to achieving universal health coverage against a backdrop of rising health expenditure and aging populations. Implementing strong primary health care requires grassroots understanding of health system performance. Comparing successes and barriers between countries may help identify mutual challenges and possible solutions. This paper compares and analyses primary health care policy in Australia, Malaysia, Mongolia, Myanmar, Thailand and Vietnam. Data were collected at the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Asia-Pacific regional conference in November 2017 using a predetermined framework. The six countries varied in maturity of their primary health care systems, including the extent to which family doctors contribute to care delivery. Challenges included an insufficient trained and competent workforce, particularly in rural and remote communities, and deficits in coordination within primary health care, as well as between primary and secondary care. Asia-Pacific regional policy needs to: (1) focus on better collaboration between public and private sectors; (2) take a structured approach to information sharing by bridging gaps in technology, health literacy and interprofessional working; (3) build systems that can evaluate and improve quality of care; and (4) promote community-based, high-quality training programs.
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Affiliation(s)
- Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295. Japan; and Corresponding author.
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, PO Box 9101, 6500HB Nijmegen, The Netherlands; and Department of Health Services Research and Policy, Australian National University, 63A Eggleston Road, Acton, ACT 2601, Australia
| | - Karen Flegg
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA), 12A-05 Chartered Square Building, 152 North Sathon Road, Silom, Bangrak, Bangkok 10500, Thailand
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Tin Myo Han
- Myanmar General Practitioners Society, No. 246, Theinbu Road, Mingalar Taung Nyunt Township, Yangon 11221, Myanmar
| | - Sairat Noknoy
- The Royal College of Family Physicians of Thailand, 11th Floor, The Royal Golden Jubilee Building, New Petchaburi 47 Road, Bangkapi, Bangkok 10310, Thailand
| | - Myagmartseren Dashtseren
- Department of Family Medicine, Mongolian National University of Medical Sciences, Zorig Street, POB 48/111, Ulaanbaatar 14210, Mongolia
| | - Pham Le An
- Family Medicine Training Center, University of Medicine and Pharmacy, 217 Hong Bang Street, District 5, Ho Chi Minh City 700000, Vietnam; and Vietnamese Association Family Physician, 217 Hong Bang Street, District 5, Ho Chi Minh City 700000, Vietnam
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Kamaliah Mohd Noh
- Cyberjaya University College of Medical Sciences, Persiaran Bestari, Cyber 11, 63000 Cyberjaya, Selangor Darul Ehsan, Malaysia
| | - Meng-Chih Lee
- Institute of Medicine, Chung Shan Medical University, 110 Section 1, Chien Kuo North Road, Taichung 40201, Taiwan; and Institute of Population Health Sciences, National Health Research Institutes, Miaoli, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - Amanda Howe
- Health Services and Primary Care, Norwich Medical School, University of East Anglia, Norwich Research Park, Earlham Road, Norwich, Norfolk NR4 7TJ, UK
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, PB 92 019, Auckland 1142, New Zealand
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Abdullah A, Liew SM, Ng CJ, Ambigapathy S, V Paranthaman PV. Health literacy experiences of multi-ethnic patients and their health-care providers in the management of type 2 diabetes in Malaysia: A qualitative study. Health Expect 2020; 23:1166-1176. [PMID: 32686277 PMCID: PMC7696131 DOI: 10.1111/hex.13095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) require adequate health literacy to understand the disease and learn self-management skills to optimize their health. However, the prevalence of limited health literacy is high in patients with T2DM, especially in Asian countries. OBJECTIVE This study aimed to explore experiences related to health literacy in Asian patients with T2DM. DESIGN This is a qualitative study using in-depth interviews and focus group discussions. A framework analysis was used to analyse the data. SETTING AND PARTICIPANTS articipants (n = 24) were multi-ethnic patients with T2DM (n = 18) and their primary health-care providers (n = 6). This study was conducted in four primary health-care clinics in Malaysia. RESULTS Nine subthemes were identified within the four dimensions of health literacy: accessing, understanding, appraising and applying information. DISCUSSION Motivated patients actively sought information, while others passively received information shared by family members, friends or even strangers. Language and communication skills played important roles in helping patients understand this information. Information appraisal was lacking, with patients just proceeding to apply the information obtained. Patients' use of information was influenced by their self-efficacy, and internal and external barriers. CONCLUSION In conclusion, the experiences of multi-ethnic patients with T2DM regarding health literacy were varied and heavily influenced by their cultures.
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Affiliation(s)
- Adina Abdullah
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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